Men with Bipolar Disorder at Higher Risk for ED, Study Finds

Men with newly-diagnosed bipolar disorder are at higher risk for erectile dysfunction (ED) than men without the condition, scientists report in the Journal of Sexual Medicine.

Past research has shown associations between ED and other mental health disorders, including depression, anxiety, and psychotic disorders. Little is known about the connection between ED and bipolar disorder, even though the two conditions share risk factors like diabetes and substance abuse.

In addition, ED is a common side effect of medications used to treat bipolar disorder, including mood stabilizers, antipsychotics, and antidepressants.

This study examined the relationship between ED and bipolar disorder among a cohort of men in Taiwan.

Using information from Taiwan’s National Health Insurance program, researchers identified 5,150 men with newly-diagnosed bipolar disorder. For each case, two matched controls without bipolar disorder were selected from the same database. The men ranged in age from 15 to 65; their average age was 37 years.

In general, men with bipolar disorder were more likely to have ED, with 2.12% of that group reporting ED compared to 0.95% of the control group. The rate remained higher for the bipolar group even after accounting for comorbidities like chronic kidney disease, high blood pressure, a history of stroke or alcohol abuse, peripheral vascular disease, and hyperlipidemia.

Men in the 25- to 34-year-old age group were at the highest risk for ED, which might be explained by younger men’s sexual frequency and awareness of sexual problems, the authors said. They added that ED incidence was higher in men over age 45, which is consistent with previous research.

While drugs for bipolar disorder can have sexual side effects like ED, men who were not actively treated with medications were still at higher risk. Past research has shown lower testosterone levels in men with bipolar disorder, and it’s possible that sleep disturbances associated with bipolar disorder might affect hormones as well.

The authors pointed out that the percentage of men with ED in both groups was much smaller than the previously-reported prevalence rate of 27% among men in Taiwan. They explained that their data might reflect Taiwan’s conservative culture, in which sexual health discussions between men and healthcare providers are infrequent. Also, claims data in this study were limited in terms of ED assessments. Still, the ED rate in the bipolar group was still more than twice that of the control group, a finding that future studies might explore further.

Several limitations were acknowledged. For example, other factors that can contribute to ED, including diet, smoking status, and physical activity, were not reported. Also, while the data revealed that medications were prescribed, the researchers did not know whether men were compliant with their treatment or if dosing had any effects on erectile function.

Overall, however, the authors recommended that physicians “consider the risk of ED” when treating bipolar patients.